What a traffic jam taught me…

Non-traditional ideas could be brought to bear to increase access to healthcare services

During a recent visit to New York City, I watched on three separate occasions as an ambulance, sirens blaring and lights flashing, struggled to weave its way through Manhattan traffic on its way to an emergency call.

I was reminded of the work that Bevan and Hamblin did in 2009 in which they looked at the percentage of ambulances that were able to achieve response times of less than eight minutes in England and Wales after instituting changes to models of governance in healthcare. What Bevan and colleagues found was that only 75 per cent of ambulance calls in England (and even less in Wales) were able to meet the threshold of an eight minute response time.

Now, if you're anything like me, you probably think that 75 per cent is low. And if you don't, let's re-frame this statistic: 1 out of every 4 calls to request an ambulance in England did not meet the established threshold of an eight minute response time. Let's continue to frame this: if I told you that your local hospital had a 25 per cent post-surgical complication rate or that patients requiring re-admission within 30 days after discharge was 25 per cent or that your doctor's waiting list had grown by 25 per cent, you surely would be unhappy with any of these results.

Seventy-five per cent may be good in many things - but it is not in healthcare. We don't know how many of these emergency calls were missed by one second, one minute or longer and there's no evidence to suggest, in this study, that mortality rates were higher or that any of the missed thresholds resulted in patient deaths. For that matter, an ambulance can arrive well within the time threshold and still not save a patient. And finally, we don't know how many of these calls were really 'medical emergencies'. To be clear, the data is murky at best.

The solution is obvious isn't it? We need more ambulances on the streets - don't we? Presumably, the more you have, the greater the likelihood of one being close to an emergency call and not having to deal with gridlock. Or maybe we need special ambulance 'lanes' on the road to allow emergency access? Or maybe we should just 'train' citizens better through the use of public service announcements delivered via conventional/social media to understand when to call an ambulance versus driving themselves to the emergency department? Over time, maybe we would see fewer calls and, as a result, fewer opportunities for missing the magical eight minute threshold.

But let's go back to our Manhattan ambulance scenario. Depending on where you live, you have probably seen a proliferation of bike couriers over the last two decades or so. The conventional automobile courier has been replaced by the bike courier in the heart of congested cities around the world where law firms, and accounting firms (and just about any other business) that rely on time sensitivity for their packages have recognised that simple documents can't afford to sit in traffic.

In fact, where I live and work, the downtown core of my city has police officers on bicycles patrolling the streets. Another example? My postman delivers the mail by biking through the neighbourhood. And to top it all off, I can find more than a handful of pizza chains that will deliver you a pizza by bike or scooter to avoid lengthy delays that come with traditional pizza delivery by car.

The point of access in healthcare doesn't have to be fixed - can't we instead find flexibility?

So, why can't we equip and outfit a small group of 'first responders' like emergency medical technicians (EMTs) with bikes or motorised scooters to reach patients who need help in a quicker fashion? Naturally, they wouldn't have all the accoutrements of an ambulance but even the basics might be useful (an advanced first-aid kit, defibrillator, oxygen, etc). Is this the panacea to the problem? Surely not, but maybe fewer and fewer patients slip through the cracks.

Opponents of this idea (not anyone who is reading this column) will throw up barriers: it's cumbersome to implement, it's costly, how will we measure success and what trade-offs do we have to make to our existing services to enable this to happen? But maybe, just maybe, we stumble upon an idea - borrowed from other parts of the private and public sectors - that changes the paradigm (for the bustling metropolis of the world at least) in how we deliver care. And maybe we change the thinking that the point of access in healthcare is 'fixed' and instead recognised both flexibility and fluidity within it. And maybe we realise that increasing access to services is not solely a patient problem, but that it's also a provider problem. It's really not that complicated - in fact, it's as easy as riding a bike.